Reason for attending the office: This patient attended for a checkup of an unrelated issue and it was during this first visit that the chiropodist noticed an abnormal left foot position. After questioning the patient, the foot had been getting gradually flatter and on assessing and pressing the foot (called palpation), the chiropodist was able to determine there was a damaged tendon – something called Posterior Tibial Tendon Dysfunction which had led to weakness and the acquisition of an adulthood flat foot.
Agreed treatment: The chiropodist arranged an ultrasound scan via the patient’s physician – this confirmed the suspected tendon damage with tearing. A short-term plan was agreed which included the assessment of gait and biomechanics in order to accurately prescribe both custom orthotics and appropriate orthopedic shoes. A medium-term plan was implemented with the patient’s physician to include a review with orthopedics so that the possibility of surgical management could be discussed as a medium-to-long term measure.
Alternative Treatment Discussed: Additional and supplemental treatment is available and included Low Level Laser Therapy, Ultrasound therapy, extracorporeal shockwave therapy or possible cortisone injection therapy to site of maximal tenderness.
Outcome: Orthotics and orthopedic shoes aim to offload the injured tendon by reducing forces acting on the foot, muscle and tendon. The photographs and video below show the outcome of an effective foot orthotic and orthopedic shoe on adult acquired flat foot.
Timeframe: After 5 months, the patient is wearing the orthopedic shoes and running shoes and medium/long term awaits the outcomes of an orthopedic surgical treatment plan.
Conclusion: This is an example how chiropodists are able to pick up on problems, act quickly to help in their assessment, diagnosis and treatment before they have a major impact on the patient’s life or lifestyle. We aim to help keep patients mobile and active so that they decide for themselves the right time for any future elective orthopedic surgery.
Please note that in most evidence hierarchies current, well designed systematic reviews and meta-analyses are at the top of the hierarchy, with single case studies, expert opinion and anecdotal experience at the bottom.